Page 21 - Delaware Medical Journal - November/December 2019
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PUBLIC HEALTH
cases of VAPI in Delaware that meet the
fatal. The 17 cases further break down Nine individuals reside in New Castle
people reported using THC e-cigarette products alone; seven reported using THC in combination with nicotine. One case involved vaping medical marijuana. Five of the 17 individuals reported using e-cigarette products using nicotine only. The average age of the patients is 28. As under investigation.
DPH is carefully considering all options for public and policy recommendations. This is a complex nationwide investigation, and there are still many unknown factors, so we, as the health agency, want to proceed with caution. No one product or device has been that vaping of THC products alone or in combination with nicotine e-cigarette products has been reported in the majority of cases nationwide.
DPH has asked the medical marijuana compassion centers to post signage advising patients to refrain from vaping for their medical use and to consult their health care providers for alternatives if they have been vaping medical marijuana. If you do not have a level of knowledge that makes you comfortable advising your patients product alternatives, you may want to refer them to compassion center staff product composition.
including Delaware, have reported at least one vaping-related illness. There
lung injury associated with the use
of e-cigarette and vaping products throughout the U.S., according to the
DPH and the CDC recommend health care providers:
■ Report cases of lung injury of unclear etiology and involving a history of e-cigarette or vaping product use within 5156. Reporting of lung injury cases
may help the CDC and state health departments determine the cause of these lung injuries.
■ Screen all patients for e-cigarette or vaping product use, including products containing nicotine and THC.
■ Among those who report e-cigarette
days, ask them about signs and symptoms of respiratory illness.
■ If e-cigarette or vaping product use is suspected as a possible etiology of a patient’s lung injury, obtain detailed history regarding:
• Substance(s) used: nicotine, cannabinoids (e.g., marijuana, THC, THC concentrates, CBD, CBD oil, synthetic cannabinoids [e.g., K2 or or other substances
• Substance source(s): commercially available liquids (i.e., bottles, cartridges, or pods), homemade liquids, and re-use of old cartridges or pods with homemade or commercially bought liquids
• Device(s) used: manufacturer; brand name; product name; model; serial number of the product, device, or e-liquid; whether the device can be customized by the user; and any
(e.g., exposure of the atomizer or heating coil)
• Where the product(s) were purchased
• Method of substance use: aerosolization, dabbing, or dripping
• Other potential cases: sharing e-cigarette products (devices, liquids,
■ Determine whether any remaining product, including devices and liquids, are available for testing. Testing can be coordinated with DPH.
■ Consider all possible causes of illness in patients reporting respiratory and gastrointestinal symptoms. Evaluate
and treat for other possible causes of illness (e.g., infectious, rheumatologic, neoplastic) as clinically indicated. Consider consultation with specialists (pulmonary, infectious disease, critical care, medical toxicology) as appropriate.
■ Decide whether to use corticosteroids. Clinical improvement of patients with lung injury associated with e-cigarette use has been reported with the use of corticosteroids. The decision to use corticosteroids should be made on a case- and the likelihood of other etiologies.
■ Decide whether to perform a bronchoalveolar lavage (BAL) based
on individual clinical circumstances. Lipoid pneumonia associated with inhalation of lipids in aerosols generated by e-cigarettes has been reported based on the detection of lipid-laden alveolar macrophages obtained by BAL and lipid staining (e.g., Oil Red O, Sudan Black).
■ Consider consultation with specialists in pulmonary medicine and pathology to help inform any evaluation plan. Lung biopsies have been performed
on some patients. If a lung biopsy is
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